ABSTRACT
Objective To compare the intraoperative wake-up test performed under different meth-ods of anesthesia in the patients undergoing scoliosis correction. Methods Sixty American Society of An-esthesiologists physical status Ⅰ or Ⅱ patients of both sexes, aged 14-35 yr, undergoing elective scoliosis correction, were divided into dexmedetomidine-based anesthesia group (D group) and sevoflurane-based anesthesia group (S group), with 30 cases in each group. Patients were tracheally intubated after induc-tion of anesthesia. Maintenance of anesthesia was as follows: remifentanil 0. 3 μg·kg-1 ·min-1 was intra-venously infused, dexmedetomidine 0. 2 μg·kg-1 ·h-1 was intravenously infused in group D, and group S inhaled low flow sevoflurane 1 L∕min with the end-tidal concentration of 0. 8％ - 1. 5％. Narcotrend index value was maintained at 30-45. The wake-up time, adverse events, requirement for vasoactive agents and blood loss during wake-up test were recorded. The wake-up quality was evaluated. Results All the pa-tients successfully completed wake-up tests. Compared with group S, the wake-up quality was significantly increased, the incidence of agitation and bucking was decreased during wake-up test, the blood loss was reduced during wake-up test (P<0. 05), and no significant change was found in wake-up time or require-ment for vasoactive agents in group D (P>0. 05). Conclusion Dexmedetomidine-based anesthesia pro-duces better efficacy for intraoperative wake-up test than sevoflurane-based anesthesia in the patients under-going scoliosis correction.
ABSTRACT
Objective To evaluate the relationship between antithrombin Ⅲ(ATⅢ)genetic pol-ymorphism and individual variation in anticoagulant effect of heparin in the patients of different nationalities. Methods Sixty patients of Uighur nationality and 60 patients of Han nationality, aged 18-64 yr, with body mass index of 21-25 kg∕m2, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, undergo-ing elective cardiac surgery under cardiopulmonary bypass, were divided into Uighur group and Han group, respectively. ATⅢ gene polymorphism was detected by polymerase chain reaction(A∕G was heterozygous, A∕A and G∕G were homozygous). Heparin sodium was intravenously injected at 5 min before the start of cardiopulmonary bypass with an amount of ACT≥480 s. The amount of heparin and protamine, intraoper-ative blood transfusion and postoperative 24 h drainage(pericardium, mediastinum∕thoracic cavity)were recorded. Activated partial thromboplastin time and prothrombin time were measured at 10 min before opera-tion and 24 h after operation. Results Compared with Han group, the amount of heparin, ratio of prota-mine to heparin for heparin neutralization and requirement for intraoperative blood transfusion were signifi-cantly decreased, the postoperative drainage volume was decreased, activated partial thromboplastin time was shortened at 24 h after operation, the frequency of A∕A genotype was increased and the frequency of G∕G genotype was decreased at ATⅢ gene single-nucleotide polymorphism sites rs5877 and rs5878, and the minimum allele(A>G)frequency was increased in Uighur group(P<0.05). Conclusion ATⅢ gene polymorphism may be one of the mechanisms underlying individual variation in anticoagulant effect of hepa-rin between the patients of Uighur nationality and Han nationality.
ABSTRACT
Objective To evaluate the efficacy of different doses of glucocorticoid for prevention of postoperative complications in patients undergoing coronary artery bypass grafting (CABG).Methods We searched PubMed,EMBASE,Highwire,CENTREN and its affiliated clinical trial registration data center,Chinese Biomedical Database,and CNKI from 2000 to 2010 for randomized controlled trials involving the efficacy of different doses of glucocorticoid for prevention of postoperative complications in patients undergoing CABG.The quality of the studies was evaluated by the method recommended by Cochrane Collaboration.Evaluation indexes included development of fibrillation,requirement for insulin treatment because of hyperglycosemia,infection,and death (during stay in hospital or within 30 days after discharge from hospital) after operation and mechanical ventilation time.Meta-analysis was conducted using the RevMan 5.1 software.Results Twenty-one randomized controlled trials involving 1737 patients were included in our meta-analysis.Different doses of glucocorticoid decreased the risk of fibrillation,and did not increase the risk of various causes-induced infection and death.Moderate and large doses of glucocorticoid increased the risk of requirement for insulin treatment because of hyperglucosemia.Large dose of glucocorticoid resulted in prolongation of ventilation time.Conclusion Different doses of glucocorticoid can decrease the development of postoperative fibrillation without increasing the risk of infection and death,moderate and large doses of glucocorticoid increase the risk of requirement for insulin treatment because of hyperglucosemia and large dose of glucocorticoid increases the risk of prolonged ventilation time in patients undergoing CABG.